15100004CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 15100004
18641 CYNTHIAAVE CUPERTINO CA 95014 (375 23 003)
D W K
CONSTRUCTION
CUPERTINO, CA 95014
OWNER'S NAME: LU SHA & DONG MING
DATE ISSUED: 02/03/2016
OWNER'S PHONE: 408-644-3995
PHONE,NO: (408) 429-8503
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class D Lic. # 2 27
Contractor D W K CONSTRUCTION Date 05/31/2017
—BLDG —ELECT _ PLUMB
MECH
RESIDENTIAL_ COMMERCLAL
I hereby affirm. that I am licensed under the provisions of Chapter 9 (commencing
_ _
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
CONSTRUCT (N) 2 STORY SFD (2629 S.F.); FRON
r PORCH
I hereby affirm under penalty of perjury one of the following two declarations:
(69 S.F.); REAR PORCH (528 S.F.) WITH ATTAC
D
t. I have and will maintain a certificate of consent to self -insure for Worker's
GARAGE (422 S.F.) "SUNNYVALE SANITARY"
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
`
REV #1 - CHANGE LOCATION OF 2ND FLOOR B
CONY; REVISE
. I have and will maintain Worker's Compensation Insurance, as provided for b
/ P P y
KITCHEN/BREAKFAST ROOM LAYOUT; REVIS
ENTRY LAYOUT.
Section 3700 of the Labor Code, for the performance of the work for which this
ISSUED: 6/27/2016
permit is issued.
Sq. Ft Floor Area:
Valuation: $400000.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
375 23 003
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree to save indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK ISN
T STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT IS
SUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST C L D,SP
CTION.
/
Signature Date 6/27/2016
Issued by: ALEX VALLELUNGA
OWNER -BUILDER DECLARATION
Date: 02/03/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material be
rig installed. If a roof is
t. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to rem
Dve all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
z. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 6/27/2016
I hereby affirm under penalty of perjury one of the following three declarations:
i. I have and will maintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A"
OR BETTER
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOR
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under
Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 255
3, and 25534. 1 will
permit is issued.
maintain compliance with the Cupertino Municipal Cod
, Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued, I
Health &c Safety Code, Section 25532(a) should I store
or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices
which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality
Management District I
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cupertino Municipal
Code, Chapter 9.12 and
Labor Code, I must forthwith comply with such provisions or this permit shall
the Health & Safety Code, Sections 25505, 255
3, and 25534.
be deemed revoked.
Owner or authdeized agent:
APPLICANT CERTIFICATION
Date: 6/27/2016
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING A EPI
Y
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending ager
cy for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, CiN
C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCIRTECT'S DECLARATIO
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date 6/27/2016
Licensed
Professional
CONSTRUCTION PERNAHT APPLICATION
CO1\/rNUNITY DEVELOPNiEN i DEPARTMENT - BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255
(=UPEEtT[ht0 (408) 777-3228 • FAX (408) 777-3333 bWdinq(c0cuperflno.orq
❑ NEW CONSTRUCTION ❑ SDDITION ❑ALTERATION / TI REVISION / DEFERRED
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PLA\TII;G APDL - ❑ NO PLAI\"NING APPROVAL LETTER
EICHLER HO?tiE? ❑ O
Ey my signature below, I certify to each of the following: I am the property owner or authorized age-lt to act on the proper ry owner's behalf.
I have read thi s
application and the infoiniation I have provided is correct. I haye read the Description of )Fork and verity it is accurate. I z_ree to comply ,>vi'
i all applicable local
ordinances and state laws relating to buildin.- construction. T 2uihorize rep:eseatatives of Cuoe: oto epees the above�-ident»ied pI perms for inspection
puiToses.
Signanure of Applicant/Agent: Date:
SLP PLEIiEN I\FOR. SATION REQUIRED�.
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PLSCHECT1_PE
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OtiTI\G SLIP r
New SFD or hiultiialnily dn: ellings: Apply for demolition peri -nit for
LT O\ ER TuE COLITFR
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ea:stina building(s). Demolition peiir,it is required prior to issuanc of buil_dil.5
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ions if any Hazardous'-\!aterials are b eumg used as Dai L oI this pr0jj CI,
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Copy of Planning Appro\>al Letter or`eetirg \,:di Planning prior to
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Bld&pp-201 l.doc revised 05121/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT, NO: 15100004
18641 CYNTHIAAVE CUPERTINO CA 95014 (375 23 003)
(D W K
CONSTRUCTION)
CUPERTINO, CA 95014
OWNER'S NAME: LU SHA & DONG MING
DATE ISSUED: 02/03/2016
OWNER'S PHONE: 408-644-3995
PHONE N0: 408.429-8503
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lie. #820027
Contractor ( D W K CONSTRUCTION ) Date 02/03/2016
—BLDG _ ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
_ MECH _ RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
CONSTRUCT (N) 2 STORY SED (2629 S.F.); FRONT
ORCH
I hereby affirm under penalty of perjury one of the following two declarations:
(69 S.F.); REAR PORCH (528 S.F.) WITH ATTACHED
i. I have and will maintain a certificate of consent to self-insure for Worker's
GARAGE (422 S.F.) "SUNNYVALE SANITARY"
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1, I have and will maintain Worker's Compensation Insurance, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which
Sq. Ft Floor Area:
Valuation: $400000.00
this permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
APN Number:
Occupancy Type:
ordinances and state laws relating to building construction, and hereby
375 23 003
authorize representatives of this city to enter upon the above mentioned
property for inspection purposes. (We) agree to save indemnify and keep
harmless the City of Cupertino against liabilities, judgments, costs, and
PERMIT EXPIRES IF WORK IS NO
r STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT IS
CE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non-point source regulations per the Cupertino Municipal
180 DAYS FROM LAST CA
Code, Section 9.18.
VON.
"---
Issued by: MELISSA
Signatuf Date 02/03/2016
Date: 02/03/2016
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material beinj
installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to re mo
all new materials for
i. I, as owner of the property, or my employees with wages as their sole "
inspection,.
compensation, will do the work, and the structure is not intended or offered
for sale (See.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property am exclusively contracting with licensed
Date: 02/03/2016
contractors to construct the project (See.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations;
ALL ROOF COVERINGS TO BE CLASS "A"
BETTER
t. 1 have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
HAZARDOUS MATERIALS I L
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under
Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533
and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code,
Chapter 9.12 and the
this permit is issued.
Health & Safety Code, Section 25532(a) should I store or
handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionatly, should I use equipment or devices
air contaminants as defined by the Bay Area Air Quality Management
which emit, hazardous
District I
shall not employ any person in any manner so as to become subject to the
will maintain compliance with the Cupertino Municipal C
de, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Ce, Sons 2550 5533
and 25534.
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shallOwner
or authorized agent:'
be deemed revoked.
Date: 02/03/2016
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGEN
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency
for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C
)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally, the applicant
I understand my plans shall be used as public records.
understands and will comply with all non-point source regulations per the
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date 02/03/2016